Healthcare Provider Details

I. General information

NPI: 1750400685
Provider Name (Legal Business Name): RISA B AGIN LEVIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 W PASSAIC ST 4TH FLOOR
ROCHELLE PARK NJ
07662-3027
US

IV. Provider business mailing address

336 W PASSAIC ST 4TH FLOOR
ROCHELLE PARK NJ
07662-3027
US

V. Phone/Fax

Practice location:
  • Phone: 201-845-7030
  • Fax: 201-845-0899
Mailing address:
  • Phone: 201-845-7030
  • Fax: 201-845-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number44SC04902500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: